Provider Demographics
NPI:1164177051
Name:BATTLE BORN HOME HEALTH LLC
Entity Type:Organization
Organization Name:BATTLE BORN HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-708-3520
Mailing Address - Street 1:307 W WINNIE LN STE 5
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2145
Mailing Address - Country:US
Mailing Address - Phone:775-788-1763
Mailing Address - Fax:775-788-1299
Practice Address - Street 1:307 W WINNIE LN STE 5
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2145
Practice Address - Country:US
Practice Address - Phone:775-788-1763
Practice Address - Fax:775-788-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health